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General NPI Number Information
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NPI Number | 1033167754
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Entity Type | Individual
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Provider Name | GARY BOLDEN R.K.T.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 25 M ST SW THIRD FLOOR (3RD.) S.W.
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City | WASHINGTON
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State | DC
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Zip | 20024-3621
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Country | US
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Telephone | 817-361-0602
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 5TH ST S
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City | ARLINGTON
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State | VA
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Zip | 22204-1932
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 226300000X
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Taxonomy Name | Kinesiotherapist
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License Number | 1469
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License Number State | IL
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